Last night was a late night at work, and I didn't have time to apply my usual annoyingly long-winded analysis to a study that I found interesting and had intended to look at today. It'll keep. In the meantime, there are always the brief "link-and-comment" (or in my case "link-and-snark") posts. Also, there was an article a couple of days ago that I have been meaning to bring up since I saw it but somehow allowed myself to get distracted. With the impending resurgence of measles and other previously controlled or even vanquished infectious diseases, courtesy of Jenny McCarthy, Generation Rescue, and their supporters and enablers, the issue described in this story is going to become more and more contentious:

Karey Williams never thought a parenting decision would come between her and a good friend. The two had known one another for a decade, supported each other through infertility treatment and had their first babies around the same time. But when she told the friend that she had stopped vaccinating her daughter at age 1, the relationship abruptly ended.
"She said, 'Well then, your child can't come into my house,'" recalls Williams, 47, who lives in the Chicago area.

That's not the only time Williams has encountered conflict because of the decision she made for her daughter, now 7. "I've had people voice their opposition to me, that I'm ruining the herd immunity ... that my child would put their child at risk," she says.

The people voicing those sentiments are exactly right. Parents like Karey Williams are contributing to exactly that, and it is good to see that many parents actually understand this:

Jennifer Collado, 37, of Glen Rock, N.J., says members of her son's toddler play group were "stunned" when one mother mentioned that her child wasn't vaccinated. The group didn't kick them out though, and shortly after they moved out of state. But the group felt that information should have been mentioned upfront. "Someone pointed out to her that it was her choice to do that but that she was putting everyone's kids in jeopardy by not having her kids vaccinated," Collado says.
Indeed.

Many parents who choose not to vaccinate will argue that it is no one else's business but their own, that they're not hurting anyone. Poppycock. (I had intended to use another word, but I'm trying to clean up my language after a few recent lapses.) By their decision not to vaccinate, antivaccinationists make their child a potential nidus of infection for their community, something they either cannot understand or refuse to understand:

This is the part I'll never understand...if the parents who vaccinate their children have such confidence in the vaccines themselves, then an unvaccinated child could never harm their protected child. Which one is it? Do they believe that vaccines work with all kids 100% of the time or don't they?
Here's the simple answer: Vaccines are not 100% effective. Nothing in medicine is. They may be 99% effective, 95% effective, 90% effective, or even less. By medical standards, any intervention that's over 90% effective is a pretty darned good intervention, and most vaccines are at least pretty darned good, especially given how rare serious reactions are. But they are not 100% effective, and it is almost as foolish for parents who vaccinate their children to believe that vaccines will be 100% effective in protecting their children as it is for antivaccinationists to believe that vaccines do more harm than good. At the very least, it's naive. Also, there are children who for health reasons cannot be vaccinated and who thus rely on herd immunity. The larger the population of unvaccinated children, the weaker the herd immunity, and if the percentage of vaccinated children falls below a certain point herd immunity basically collapses. Indeed, one of the parents in the article doesn't seem to understand that:

Angela Corry, 33, of Shirley, N.Y., has faith that vaccinations are going to protect both of her girls, no matter who they encounter.
"I have no problem welcoming unvaccinated children into a play group, and I have no problem with them attending school," she says. "Simply put, my children are vaccinated, the risk is minimal. I may not agree with [other] parents' choices, but there's no reason to hold that against the child."

Actually, I would argue that it is the parent of the unvaccinated child who is responsible for any ostracism that child suffers due to their decision not to vaccinate. It is not incumbent on parents of vaccinated children to bend over backwards to accommodate non-vaccinators. Also, if herd immunity collapses, the risk will no longer be minimal, and, make no mistake about it, the antivaccine movement is a dagger aimed at the heart of herd immunity.

One thing that I find heartening this article is that the social norm is still to vaccinate and that most parents still support vaccination even in light of the contininuous antivaccine propaganda pumped out by Jenny McCarthy and her fellow travellers. Antivaccinationists may be tolerated in the abstract, but when the rubber hits the road and it's one's own children potentially at risk due to them suddenly that tolerance is severely strained:

But parents who don't know who's vaccinated and who isn't have their own concerns, highlighted by the measles outbreak in San Diego earlier this year that resulted when an unvaccinated 7-year-old boy traveling to Switzerland contracted measles. The virus spread to 11 other unvaccinated children at both his school and his pediatrician's office -- including a few babies who were too young to receive the measles, mumps and rubella (MMR) vaccine.
When news of the outbreak hit, Dr. Ari Brown says her office in Austin, Texas, received a spate of questions from worried mothers wondering if there were any nonvaccinating families in her practice, which there aren't. "Parents were outraged," she says.

"From the vaccinating parent perspective, it's a little infuriating because you don't know who these kids are," says Brown, a vaccine proponent and co-author of the book "Baby 411."

Yes, it is, hence the question being asked of parents whose children are going to play with other children. Naturally, antivaccinationists are outraged:

"Do I think it's inappropriate to put a mark on people and kick them out from being able to participate in society, yeah I think it's inappropriate -- it's inappropriate and it's dangerous," says Barbara Loe Fisher, cofounder and president of the National Vaccine Information Center, a group in Vienna, Va., that describes itself as "America's Vaccine Safety Watchdog" and opposes forced vaccinations.
Fisher, "Libertarian" that she is who so forcefully opposes "forced" vaccination or anything that "tells her what to do about her child's health" seems to think that she should be able to make her decision not to vaccinate and face zero consequences, that she shouldn't face societal displeasure at her decision. In other words, for all her piously hypocritical appeals to "freedom," she clearly thinks her rights trump everyone else's. But what about parents who do the right thing by having their children vaccinated and do not want to put their children at risk from children whose parents are less responsible? This has nothing to do with government telling Fisher what to do and everything with shared values of society, where a parent wants to know if she's putting her child at risk by letting that child play with another child. As part of assessing that risk it's perfectly reasonable to want to know the vaccination status of the playmate. True, that doesn't eliminate the risk of being exposed to disease thanks to the unvaccinated in various public areas, but children playing together often involve close contact with the typical spitty and snotty hands that children in their lack of concern for hygeine often have, a far more effective means of transmitting the various infectious diseases that we vaccinate against than any random encounter with a stranger in a public place.

Now don't get me wrong. I understand that health information is private and that no parent is required to reveal her child's vaccination status to another parent. However, the flip side of that is that it is not wrong for a parent to ask about the vaccination status of potential playmates for her child. With that in mind, I'll make three points.

First, society is always a balance between competing interests of personal freedom and the good of society as a whole. In the U.S. we tend to value individual freedom over society, which has for many issues (freedom of speech, freedom of religion, etc.) served us very well indeed, although arguably not as well in others. Unfortunately, all too often advocates for "personal freedom" forget or don't care that the corollary of this balance is that one person's rights do not allow him or her to infringe on the rights of another. It's that whole "balance" thing, admittedly a cause of contention since the republic was founded. Given that schools and day care centers, with their large concentration of children in relatively small spaces, represent perfect incubators for children to pass viruses and bacteria between each other, it makes scientific, medical, public health, and legal sense to require full vaccination according to the currently recommended schedule before a child is permitted to enter school or day care, with the only exceptions being children who for medical reasons cannot be safely vaccinated. Indeed, the push for "religious" and "philosophical" exemptions undermines that protection and is intentionally being exploited by antivaccinationists to get their children into school to endanger the other children there.

Second, a parent has every right to ask about the vaccination status of potential playmates for her child. Parents of said potential playmate, whether they vaccinate or not, have every right to refuse to answer. However, the parent asking also has the right to judge for themselves whether they will accept that answer. Personally, I would not accept a refusal to answer and recommend to pro-vaccination parents out there that they refuse to accept a nonanswer as well.

Finally, and most importantly, what this conflict shows is that antivaccinationists seem to think they have some God-given right to inflict their pseudoscience on society as a whole. They don't want to vaccinate their child because of fears of autism or various other "complications" of vaccines based on fearmongering, pseudoscience, or religion? Fine, but there will be consequences, and I don't care if they don't like those consequences. Their choice based on fear is endangering the rest of society by making the resurgence of vaccine-preventable diseases more likely. If a parent makes the choice not to vaccinate, that parent should not whine when parents of vaccinated children decide that they do not want to risk their children's health by letting them play with unvaccinated children.

After all, if antivaccinationists claim have the right not to vaccinate, they should not be disturbed if the parents of vaccinated children also claim the right to take action to protect their child from the risks introduced into society by antivaccinationists "exercising their rights."

Replies to This Discussion

This public service announcement keeps playing during commercials when I'm watching TV. Every time it comes on it pisses me off because we shouldn't even need a public service announcement for a disease that we have had a vaccination for since I was a child. Unfortunately though I live in an area that has a large number of unvaccinated children we have had outbreaks of Measles and Whooping Cough (AKA Pertussis) that can be directly linked to the lack of herd immunity in the community. This issue is especially important to me since I work with young children. I don't want to fall ill nor do I want any of the children I work with to fall ill and possibly die from a preventable disease because some moron didn't vaccinate their children. I really do think people who don't vaccinate their children are morons and I think it should be considered child endangerment not to vaccinate your child.

A big problem with pertussis that most people don't realize is that the vaccine wanes after several years and few people other than healthcare workers keep up on boosters. The point of that public service announcement was to inform people that infants often contract the illness from parents and caregivers instead of other children like the majority of the population seems to think. Many places are currently pushing adult vaccination programs because of this.

Jenny McCarthy hasn't done nearly as much damage as the media likes to pretend she has. The CDC surveys show that childhood vaccination rates have remained stable, high and meet or exceed the national goals. They could still be higher in some places, but even a 100% childhood vaccination coverage would still leave the majority of the population without any increased immunity at all for illnesses like pertussis.

It's so easy to say what everyone else should do with their children, but the realities of raising children isn't nearly so cut and dry. Having a child changes you on a deep and profound level that can't be fathomed by non-parents. Before I had a kid I was a private school teacher, a preschool teacher and a nanny. I was pretty damned sure exactly how I would parent and how I would handle certain situations. Of course my baby was going to sleep in his own bed and of course my husband would take one night time feeding, to facilitate paternal bonding. Of course I'd stop nursing between six months and a year, of course he'd learn to sleep through the night by crying it out. Of course he'd go to preschool and then I'd go back to teaching private school and he'd attend. Of course, of course, of course!

The day I brought my son home from the hospital, I realized I didn't know jack about parenting. The thought of putting my baby, the being who shared a body with me for 3/4 of a year, in a crib in a separate room felt alien and wrong. The thought of him so far away was more than I could bear. When he cried at night and my husband was preparing a bottle, the thought of an artificial nipple in my boy's mouth disgusted me. When he was six months old and still nursing every single hour, the thought of weaning him seemed all wrong. When he was nine months old and refused to sleep for fear of missing something cool, letting him cry it out felt like torture. When he was three and his friends started heading off to preschool, I realized he was still so little and he still had plenty of time for education. When he was five and his friends headed off to kindergarten, I couldn't stand the thought of him being inside all day while the weather was warm and there were hikes to take and ladybugs to examine.

I have become a parent that I never thought I would be. My ideals and beliefs have changed massively, just from becoming a mother and now I know that I'll never really know anything, especially how I will feel about any given situation. Of course I started out gung-ho on vaccinations. What irresponsible parent wouldn't want to protect their child from disease? But as my son grew, so did my perceptions of the world. I started to question what our doctor said. I began to question what my grandparents and parents thought, and "everyone does it" or "it's just what's done" stopped being valid reasons for doing anything, including vaccinating. My husband was still very pro-vaccine, but I questioned him and expected intelligent dialog with him. Before I became a parent, I wasn't a Christian, but I believed in some form of god. When my son was born I started questioning faith, god, and yes, science. He received all his vaccines until he was four, but after that, I stopped them.

When he was five, I intentionally exposed my son to chicken pox because that was one vaccine that was too new for me to allow. That vaccine felt more like a ploy developed to drive the economy than for the health of children. My husband never got chicken pox and when he found out I successfully exposed our son, I thought he would divorce me...He was that pissed off.

The turning point for my husband happened when my son was six. We had a10 year old, indoor-only cat who somehow got an eye infection. We hadn't given him his rabies vaccine in years since...well, he was an indoor cat with no exposure to other cats. We took him to the vet, they gave him some antibiotics and steroid cream, and his rabies booster. They also did blood work to verify he didn't have something worse than just an eye infection. After the vaccine, but before the treatment, he got lethargic. We gave him his antibiotics and called the vet. They suggested we wait a day or two to let the reaction of the vaccine wear off before we give him another dose of antibiotics or steroids. 24 hours later he was walking in circles. 12 hours after that, he couldn't walk in a straight line at all, just in circles. He stopped eating. He stopped bathing. He refused to drink. He lost weight like crazy. Again, the tests showed he was healthy...it was just an eye infection. I had to carry the cat to the litter box, but he stopped peeing and pooping. I had to buy a syringe and force him to drink water round the clock. After about two months and two different vets, we took him back to the original vet and had him put to sleep. She, the vet, attested that yes, it was a rare reaction to the rabies vaccine that caused our cat to get sick and die a slow and very painful death. That was also the opinion of the other vets we saw.

It is one thing to say "everyone should do X, even if it poses a very minimal risk", but when that rare and minimal thing happens to you, all bets are off the table. When it's your cat who has a very traceable reaction to a vaccine and dies, when it is your child, your mother-in-law, your nephew, herd immunity ceases to matter. All anyone can ever do is to make the most informed and rational decision they can.

As a parent who turned atheist, I question everything and that puts me in a strange place. I don't believe in god, yet I also don't deify science. I will put my eggs in the science basket over the god basket every time, but I don't think science will ever have all the answers; and when it comes to the health of my child, I refuse to take blind chances on either end.

We can keep thousands maybe even millions of people from getting sick and dieing or suffering permanent injuries from easily preventable diseases if people would realize that the risk of negative side effects from a vaccine is far less than the risks of taking your child on a hike. Yes having a child changes things, things you never thought you would change but I don't think you or any other parent has the right to put my child or any other person's child at risk. That's what the vaccination debate is about... who's rights are we going to uphold? Are we going to uphold your right not to vaccinate and lower the herd immunity and potentially expose or sicken other people's children or are we going to uphold everyone's right to be healthy and safe from easily preventable disease especially when the risks of vaccination are so extremely low? As stated before I live in a community with low herd immunity and numbers of sicknesses that were for all intents and purposes non-existent not that long ago are now inching up.

I don't have children.... but! I do have children in my community that I deeply care about. I have cousins and a brother and sister. It isn't just the heart of the parent that is broken when a child dies. The siblings are effected almost [but not quite] as powerfully.

I do know that in rare and tragic cases, individuals will die from a horrific result of a vaccination. Usually that result comes because the person or animal had a compromised immune system and no one knew.

Case in point... The first dog that I ever felt was mine [though techincally it was my mother's] was my puppy, Sophie. She was tiny and beautiful. But something went horribly wrong.

The puppy was the runt of her litter. She also had a basically non-existent immune system and no one knew that. When they attempted to innoculate her to Canine Distemper, they unknowingly gave her the nearly always fatal puppy disease.

We picked her up in June 2007 when she was 8 weeks old. 2 days later we had admitted her to one of the best animal hospitals in the tri-state area. In the late afternoon the next day... we said our last goodbye before she was put down.

Sophie was an extremely rare and sad case. When her fate was visible, even the nurses were crying. But, it was an annomoly. The VAST majority of puppies go through that vaccine without any complications.

And this incident hasn't shaken my confidence in vaccines, because when it comes down to it... when making a decision such as this... you have to way the statistical factors without allowing your emotions to get in the way.

Statistically... an unvaccinated human being is FAR more likely to contract an illness and die than the chance of a vaccine going wrong.

I don't understand what it means to be a parent... but I do know this... Your son is depending on you to protect him as best you can.

Since he made it through the MMR vaccine it is unlikely that his immune system is compromised... but I'm not a doctor... DEFINITELY talk to his pediatrician! He or she can tell you better whether your fears have a foundation or not.

Secondly... know this... an "active" vaccination [one involving an alive but weakened bacterium] is more likely to go wrong than an inactive one [one that has been killed.]